The adoption of smoke-free hospital campuses in the United States.

BACKGROUND: The adoption of a smoke-free hospital campus policy is often a highly publicised local event. National media coverage suggests that the trend towards adopting these policies is growing, and this publicity can frequently lead hospital administrators to consider the adoption of such policies within their own institutions. Little is actually known, however, about the prevalence of these policies or their impact. OBJECTIVES: To determine the national prevalence of smoke-free hospital campus policies and the relation between these policies and performance on nationally standardised measures for smoking cessation counselling in US hospitals. METHODS: 4494 Joint Commission-accredited hospitals were invited to complete a web-based questionnaire assessing current smoking policies and future plans. Smoking cessation counselling rates were assessed through nationally standardised measures. RESULTS: The 1916 hospitals responding to the survey (43%) were statistically similar to non-responders with respect to performance measure rates, smoking policies and demographic characteristics. Approximately 45% of responders reported an existing smoke-free hospital campus policy. With respect to demographics, higher proportions of smoke-free campus policies were reported in non-teaching and non-profit hospitals. Smoke-free campus hospitals were also more likely to provide smoking cessation counselling to patients with acute myocardial infarction, heart failure and pneumonia who smoke (p<0.001). CONCLUSIONS: By February 2008, 45% of US hospitals (up from approximately 3% in 1992) had adopted a smoke-free campus policy; another 15% reported actively pursuing the adoption of such a policy. By the end of 2009, it is likely that the majority of US hospitals will have a smoke-free campus.

The ORYX initiative: goals and potential application to physician quality improvement efforts.

Demands for public accountability in health care are more widespread today than at any time in the past. A number of national performance measurement efforts, including the ORYX initiative of the Joint Commission on Accreditation of Healthcare Organizations, represent an effort to provide stakeholders with the data they need to make judgments about the quality of health care provided to the public. The underlying premise of performance measurement is that organizations and clinicians can only improve what they can measure. Clinicians are the natural leaders in effecting broad-based change because of their direct influence on patient care and the respect they command in the health care environment. As performance measurement initiatives evolve, the ability of health care organizations to implement empirically based, structured improvement will increase and become commonplace.

Integrating performance measure data into the Joint Commission accreditation process.

This article describes the Joint Commission's implementation plans, experience, and results to date of incorporating performance measurement data into the accreditation process. These plans have evolved in response to changes in the health care environment, feedback from accredited organizations, and both technical and political obstacles encountered. During the late 1980s, the Joint Commission developed a national performance measurement system, the IMSystem, to incorporate information about the process and outcomes of care into the accreditation process. In 1995, the ORYX initiative was introduced to offer health care organizations significant flexibility in selecting a measurement system and measures while promoting organizational self-improvement and accountability. Recently, the plans have evolved to incorporate standardized core measures that are known to be valid and reliable. These initiatives have moved the field much closer to the day when quality assessment will reflect a comprehensive view of organizational performance, based, in part, on performance measurement data.